Gastroenterology Today Summer 2022

FEATURE
GLUTEN-FREE DIET OFFERS AN
EFFECTIVE OPTION FOR THOSE WITH
IBS TO MANAGE THEIR SYMPTOMS
New research from the Sheffield Gastroenterology group has
found that a gluten-free diet offers an equally effective dietary
treatment option for those with irritable bowel syndrome (IBS)
looking to manage their symptoms, alongside first and secondline
dietary advice currently recommended.
In the largest multicentre study of its kind, researchers investigated the
long-term use of the low-FODMAP diet, the recommended second-line
dietary treatment option, amongst IBS patients originally advised on the
diet by dietitians based in 5 key UK hospitals 1 . The study found that the
low FODMAP diet had longevity and continued success for the majority
of patients with 76% continuing to follow a personalised form of the diet
up to 8 years later.
A key insight from the study was that 68% of these patients who
reported to be following a personalised low FODMAP diet in the long
term, regularly purchased specialist gluten and wheat-free products to
help manage their symptoms. This led researchers to question whether
the gluten-free diet may in fact be a simpler route to the same benefit
and whether the gluten-free diet is in fact the crux of the ‘personalised’
low FODMAP diet, which has the potential to benefit a large percentage
of IBS sufferers. This ‘FODMAP light’ or ‘FODMAP gentle’ approach
could provide an alternative ‘bottom up’ management approach for IBS
alongside the existing ‘top down’ low FODMAP diet (see fig. 1).
IBS (see fig. 2). Whilst traditional advice was found to be more patient
friendly, and so should remain the first-line dietary treatment option, the
low FODMAP diet and gluten-free diet should be considered as equally
effective second-line alternatives, based on patient preference and
specialist opinion. These findings are of particular relevance, given that
an earlier piece of research from the same team demonstrated inequity
in GI dietetic service provision across England, with regional differences
in the level of provision and extent of specialist care and insufficient time
for clinic appointments 3 . Given these findings, there is an urgent need to
consider less complex dietary interventions for common conditions such
as IBS in order to maximise efficiency and standards in patient care.
Dr Imran Aziz, Consultant
Gastroenterologist at the Royal
Hallamshire Hospital, Sheffield
commented:
“Diet appears to play a pivotal
role in symptom generation in IBS
patients. Over the last decade
there has been a substantial
increase in interest in the role of
dietary therapies in IBS, including
a gluten-free diet. This latest
research shows that a glutenfree
has a similar level of efficacy
Fig. 2
to traditional dietary and low
FODMAP dietary advice and so deserves a seat at the table. It is an
important step in providing IBS patients with choice, helping them to find
relief from their symptoms in the simplest, most effective way for them.”
GASTROENTEROLOGY TODAY - SUMMER 2022
Fig. 1
A follow-up randomised trial, led by the Sheffield team involved a headto-head
investigation looking at the best treatment options for patients
with IBS in real world conditions 2 . It compared traditional (first-line)
dietary advice, a low FODMAP diet and a gluten-free diet.
The key finding from the study was that all three diets were equally
effective in managing symptoms for patients with non-constipated
Katie Kennedy, Company Dietitian for gluten-free food manufacturer Dr
Schär who helped to fund this research, added:
“Dr Schär were delighted to support Sheffield to conduct this research, the
first study of it’s kind to compare all three major dietary interventions for
IBS. The results will empower dietitians to suggest the most appropriate
dietary treatment options for their IBS patients in a joint decision-making
process. This study proves that, if advised on and followed correctly,
traditional dietary advice can help the majority of IBS sufferers to find relief
from their symptoms, without the need for more complex and costly dietary
interventions. If traditional dietary advice fails, then there are further, equally
effective options available to patients, including a gluten-free diet”.
Further research is underway to build on these findings and provide
further impetus for a medical consensus and future change in national
guidance on IBS.
6
References
1. Rej, A, Shaw C, Buckle R et al. The low FODMAP diet for IBS: A multicentre UK study assessing long-term followup.
Dig Liver Dis 2021 Nov;53(11):1404-1411. Doi: 10.1016/j.dld.2021.05.004.Epub 2021 Jun 1
2. Rej A, Sanders DS, Shaw CC, et al. Efficacy and Acceptability of Dietary Therapies in Non-Constipated Irritable
Bowel Syndrome: A Randomized Trial of Traditional Dietary Advice, the Low FODMAP Diet and the Gluten-Free
Diet. Clin Gastroenterol Hepatol. 2022 Feb 28: S1542-3565 (22) 00202-6. doi: 10.1016/j.cgh.2022.02.045.
Online ahead of print
3. Rej A, Buckle RL, Shaw CC, et al. National survey evaluating the provision of gastroenterology dietetic services in
England. Frontline Gastroenterology 2020:flgastro-2020-101493.